Sir Ludwig Guttmann Lecture - Trends in spinal cord injury rehabilitation outcomes from model systems in the United States: 1973-2006

Study design: Consecutive case series with 5-year follow-up. Objective: To evaluate the spinal cord injury (SCI) model systems program in the United States by documenting improvements in treatment outcomes over time. Setting: SCI model systems throughout the United States. Methods: Initial data were collected on 24 332 patients injured between 1973 and 2006. Follow-up data were collected on 9225 of these patients 5 years post-injury. All data were grouped by calendar year. Descriptive statistics included means and percentages. Multiple linear or logistic regression was used to assess outcome trends after adjusting for demographics and injury severity. Results: Acute care and rehabilitation lengths of stay declined dramatically over time (P < 0.01). Mean functional independence measure motor score at discharge and gain during rehabilitation decreased, whereas gain per day increased (P < 0.01). The probability of neurologic improvement from admission to discharge increased. Odds of medical complications decreased during in-patient treatment, but increased post-discharge (P < 0.05). Rehospitalizations declined over time (P < 0.01). Community integration improved. First year mortality rates improved, but longer term mortality rates showed no improvement since 1982. Conclusions: Steady improvements have occurred for many treatment outcomes. Newer and more effective methods of prevention and treatment need to be developed to target those outcomes that have not improved and remain suboptimal. Sponsorship: This research was supported by grant number H133A011201 from the National Institute on Disability and Rehabilitation Research, Office of Special Education and Rehabilitative Services, United States Department of Education, Washington, DC.